Main Point: Current critiques of the World Health Organization fail to appreciate its formal structure as a member state-based institution, its practical constraints in acting as a supranational authority, and the enduring value of its legitimacy in sharing normative technical information in a crisis.
As the COVID-19 outbreak grows, the World Health Organization (WHO) continues to draw attention becoming one of the main targets of blame for the devastating impact of the virus despite acting in accordance to its authority pursuant to the International Health Regulations. The United States and Brazil have challenged the legitimacy of the organization, faulting the WHO for failing to independently investigate the details about transmission vectors provided by the Chinese government early in the outbreak. However, these criticisms not only misunderstand the authority of the WHO, but also undermine the specific capabilities that only the WHO can provide in addressing global health crises. Current global health governance frameworks operate by upholding state sovereignty, connecting domestic authorities across border by sharing information, rather than through robust supranationalism that allows the WHO to issue binding decrees on States, investigate on their own, or to take measures in response to inaccurate reporting. So then, what exact value does the WHO provide in a global health crisis situation?
The WHO has been granted three primary constitutional mandates: 1) to provide normative guidance to member states on technical aspects of global health, 2) to assist member states with health development, and 3) to respond to global health security threats (including both pandemic emergencies and “silent” crises such as NCDs or smallpox).
Critically, the WHO’s institutional strengths lie in its normative operations, providing expertise in setting out health norms, standards, rules, and advice. Such technocratic expertise is the WHO’s primary competency, built through decades of scientific knowledge-sharing and coordination. In times outside of a pandemic emergency, the WHO provides critical assessments monitoring pandemic preparedness of national health systems and dealing with chronic crises. For instance, prior to the COVID outbreak, the WHO was involved with publishing new Ebola vaccination strategies, addressing antimicrobial resistance, polio eradication, tropical disease outbreaks, as well as malaria eradication programs. While universities, medical societies, and other experts routinely disseminate scientific research and clinical guidance, the WHO holds unique legitimacy when providing normative leadership as a member-state based entity composed of virtually all nations. It is easier for countries to accept and recognize guidance from the WHO than from another country, foreign university, or some other expert group.
These core capacities provide the WHO with strengths that cannot be easily created or replaced in the context of an acute pandemic emergency; functions that have been largely overlooked due to the politicization of global health in 2020. From a normative perspective, the WHO brings a database of knowledge about the emergence, persistence, and recurrence of zoonotic viruses or other potential sources of pandemics. In the early stages of an outbreak, where scientific skill and expertise for identification is vital, the WHO operates as a central authority assessing the emerging data available and providing insight into aspects of viral biology, antigenic diversity, and identification of novel strains.
Managing a Global Network
Because every newly emerging virus will not present the same threat level as COVID-19, a robust global health response system needs informed scientists able to assess transmissibility and virulence, as well as determine susceptibility of the populations at risk. The reality of exigent health emergencies is that experts, often positioned from different centers around the world, must operate with limited information and at a great distance away from the outbreak’s center. WHO fills a vital role in navigating global collective action problems as a central multilateral authority figure.
The organization manages networks of information at an outbreak’s onset, promotes standards, shepherds scientific data and studies about the epidemiological spread, and disseminates technical guidance and recommendations. Of course, WHO has not been perfect in its role sharing normative guidance. For example, WHO recently issued puzzling statements regarding the extent of asymptomatic versus presymptomatic transmission of the coronavirus.
Beyond coordinating a global network comprised of both datasets and public health experts, the WHO serves a key role in the development of diagnostic and therapeutic measures. In response to epidemic emergencies, WHO is able to leverage the information available to publish and continually update guidelines on epidemiological surveillance for governments and health care workers. Additionally, WHO is critically involved in coordaining laboratory techniques ranging from testing reagents to “first candidate” vaccine development. Notably, the WHO established a COVID testing protocol that was successfully implemented by many countries in combatting the first waves of the viral spread. Most recently, the WHO worked with other partners to spearhead the Access to COVID-19 Tools (ACT) Accelerator, bringing together civil society, governments, and health organizations to speed up efforts to develop diagnostics, therapies, and vaccines to combat the pandemic.
Next Steps for the WHO
Certainly, COVID-19 has revealed gaps in the operations of the current global health governance framework, gaps that must be addressed moving forward, especially in light of far-reaching implications a pandemic has on trade, economies, and human rights. But, focusing on perceived failures of WHO undervalues its core strengths in providing credibility when coordinating scientific information. As reform proposals continued to be published, and the global health governance system is reimagined, a delineation ought to be drawn between what WHO can achieve, what issues require the establishment of new partnerships, and what issues fall outside of the WHO’s institutional skills and operations.
Adi Radhakrishnan is a J.D. Candidate focusing on International Human Rights and Global Health Law at Columbia Law School, Class of 2021 in New York City, USA